LIBRARY OF CONGRESS. 



Chap. Copyright No, 

ShelfJEAi 



UNITED STATES OF AMERICA. 



A SYLLABUS 



OF 



THE COURSE OF LECTURES 



ON 



MINOR SURGERY 



DELIVERED ANNUALLY BY 



NATHANIEL W. EMERSON, M.D., 

Associate Professor of Surgery at Boston University School of Medicine, 

Boston, Mass. 



Copyright, 1S99, 
By NATHANIEL W. EMERSON, M.D. 



SECDr: 501 r, 
16 w 3. 




40841 



HKXA^ifcb R£C€ 







LECTURES OX MINOR SURGERY. 



SYLLABUS. 



LECTURE I. 

Introductory and Explanatory. 

Outline of the meaning of Minor Surgery. As here considered, it does not concern 
itself especially with the operation, and certainly has little to do with Minor Surgical 
Operations. It is a painstaking analysis and consideration of the various problems of 
operations resolved into their ultimate parts, and concerns itself with the consideration of 
detail as such and as applied to any operation. 

It is also a study from the common-sense standpoint of the various conditions which 
affect the welfare of the patient under the particular circumstances which make it an 
individual surgical matter. 

Relations of Minor Surgery to General and Gynecological Surgery. 

Technique ; what it means ; its importance ; how it is elaborated by attention to detail. 



IO 



LECTURES ON MINOR SURGERY. 



II. 



III. 





LECTURE II. 


Preparations for an operation. 




i. Of self. 


5- 


2. Of patient. 


6. 


3. Of room for operation. 


7- 


4. Of room for patient after 




operating. 





Duties at operations. 
1. As operator. 
As on-looker. 
As friend of the patient. 
As minor assistant. 
As chief assistant. 
As assistant with instruments. 



Care of the patient. 

1. Before operation. 

2. During operation. 



Of instruments. 
Of nurses. 

Of accessories, as hot water, ban- 
dages, etc. 



7. As etherizer. 

8. To patient. 

9. To friends of the patient. 

10. To consultants. 

11. To former medical advisers. 



3. After operation. 



i6 



LECTURES ON MINOR SURGERY. 



LECTURE III. 



Hemorrhage. 
I. Classification. 

i. According to source. 4 

a. Arterial. 

b. Venous. 

c. Capillary. 

d. Parenchymatous, as from tongue. 

2. According to time. 

a. Primary. 

b. Intermediary. 

c. Secondary. 

3. According to manner of occurrence 

a. By rupture, the only cause of 

arterial hemorrhage, 
a. Traumatic. 
(3. Disease of the vessel 

walls, as in hemophilia 5 

or " bleeders." 

b. By diapedesis or transfusion ; 

spontaneous from veins 
and capillaries. 

c. By obstruction causing 

a. Thrombosis. 
(3. Embolism. 

II. Methods of arresting. 



According to quantity and when con- 
fined. 

a. Ecchymosis, or petechia. 

b. Suggillation, or sanguineous 

effusion. 

c. Hemorrhagic infarct. 

d. Hematoma, or blood tumor, 

sub-named according to 

location, 
a. Hematometra. 
{3. Hemothorax, 
y. Hematocele. 
8. Hematopericardium. 
e. Hematosalpinx, etc. 
According to location. 

a. Epistaxis. 

b. Hematemesis. 

c. Hemoptysis. 

d. Hemorrhoids. 

e. Hematuria. 

f. Menorrhagia. 

g. Metrorrhagia. 



1. Nature's method. 

a. Ends of inner coats of arteries retract and curl up. 

b. Ends of arteries contract and diminish in caliber ; surrounding tissues con- 

tract and support the end of the artery. 

c. Coagula form in arteries ; diminution in force of blood current. 

d. Organization of coagula. 

2. Exposure to air. 

3. Cold — not desirable in open wounds; will help control a concealed hemor- 

rhage. Sometimes advised in an atonic uterus after delivery. 



22 LECTURES ON MINOR SURGERY. 

LECTURE IV. 

Hemorrhage, — Continued. 

II. Methods of arresting, — Continued. 

4. Heat. 

a. Hot water — one of the best means in certain kinds of open wounds. No 

longer much used in abdomen. Iodine or alcohol added are sometimes 
• beneficial. 
Application of both heat and cold directly to open wounds are now 

procedures of emergency. 

b. Thermo- cautery. 

c. Actual cautery. 

d. Galvano-cautery. 

5. Mechanical. 

a. Position, as in flexion and extension and elevation of a part. 

b. Compression. 

a. Digital. 
/?. Tampons, 
y. Acupressure. 

rv ry . ( Field tourniquet. 

" ( Spanish windlass. 
e. Esmarch bandage. 
£. Ecraseur. 

c. Forcipressure and forceps. 

a. Serre forte. 

yS. Serre fine. 

y. Artery forceps. 

Pean. 

Spencer Wells. 

Wells' for broad ligament. 
8. Clamps for broad ligament. 
e. Clamps for large or broad pedicle, as in colotomy. 

d. Torsion. 

e. Acupuncture. 



28 LECTURES ON MINOR SURGERY. 

LECTURE V. 

Hemorrhage, — Co?itinued. 

II. Methods of arresting, — Continued, 
5. Mechanical, — Continued, 
f. Ligation. 

a. History of development. 

Suggested by oldest writers, — Galen, Celsus, Avicenna, Albucasis. 
First practised by A. Pare about 1560, and perfected by him. 
Guillemeau followed, but used " mediate ligation," and whole 

practice fell into disuse. 
Sharpe, in England, revived it in 1760 (wide and flat ligature). 
Desault, in France, favored it in 1780. 
Jones, supported by Abenethy and Sir A. Cooper, demonstrated 

in 1805 superiority of small round ligature. 
Physick, of Philadelphia, introduced animal ligatures. 
Jameson, of Philadelphia, — buckskin. 
McSweeney, 18 18; Fielding, 1826, — silkworm gut. 
Sir A. Cooper followed with catgut. 
Eve, with fibres of deer sinew. 
Recently, tendons of various animals. 

Catgut and sheep gut (submucous cellular tissue of intestines of 
lambs, sheep and goats, cleansed in alkaline bath and bleached 
in sulphurous acid), are in most common use. 
ft. Requisites of a ligature. 

1. Strong enough for compression. 

2. Able to maintain itself sufficiently long. 

3. Unirritating. 

4. Non-interference with union. 

5. Capable of spontaneous absorption, 
y. Ligatures. 

1. Silk — twisted, colorless, or iron-dyed. 

2. Hemp — in disuse. 



Animal — 

Catgut or sheep gut 
Silkworm gut 



moose, 
buffalo, 
whale, 
Tendons or sinews of -j rat, 

squirrel, 
tail of ox, 
kangaroo. 

4. Metal — in disuse. 

5. Elastic — rarely used except for temporary purposes. 

6. Preparation of ligatures. 

Aseptic by boiling in water, alcohol, cumol. 

By dry heat. 
Chromicized. 
How to preserve. 



34 LECTURES ON MINOR SURGERY. 

LECTURE VI. 

Hemorrhage, — Continued. 

II. Methods of arresting, — Continued. 
6. Styptics. 

i. Perchloride of iron, liquid. 

2. Sub-sulphate of iron, powder. 

Describe action and how gotten rid of. 

3. Turpentine undesirable. 

4. Vegetable astringents, as 

Acetic acid. 
Tannic acid. 
Gallic acid. 
Oak bark, etc. 

5. Alum, common salt. 

III. Constitutional symptoms of hemorrhage. 

Face pale, pulse weak, temperature sub-normal, dizziness, nausea and vomiting, 
specks before the eyes, roaring and noises in the ears, fainting and unconscious- 
ness. If patient grows worse, then face pinched, gray, and waxy; nose cold, 
drawn and pointed ; lips and tongue blue ; eyes dull and glazed ; body cold, 
especially hands and feet ; blue under nails ; pulse thready, small, frequent, 
imperceptible ; unconsciousness ; death. 



40 LECTURES ON MINOR SURGERY. 

LECTURE VII. 

Hemorrhage, — Continued. 

IV. Immediate treatment of hemorrhage. 

i. Absolute rest, mental and physical. 

2. External heat : hot water-bottles and blankets. Do not burn patient. Accident 
of burning too frequently happens. Patients under anaesthesia burned more 
easily than under other conditions. 

a. Brandy, hypod. thirty gtts, or by mouth. 

b. Ammonia by inhalation. 

c. Camphor, thirty parts, sweet oil, seventy parts, hypod. 

d. Strychnia, 1/60 gr., hypod. 

e. Digitalis, 1/100 gr., hypod. 

f. Normal salt solution. 

y. Sub-cutaneous injection of 

z. Intravenous injection of two to five pints. 

g. Transfusion, obsolete, displaced by last. 

h. Counteract exhaustion ; do not over-stimulate ; sometimes opiates. Give 
water freely to drink. 

V. Constitutional treatment. 

China, ipecac, bell., hyper., secale, phos., arnica, canth., hamamelis, ferrum, 
nux vomica. 



46 LECTURES ON MINOR SURGERY. 

LECTURE VIII. 
Knots. 

i. Square or reef knot. 5. Wesselhoeft. 

2. " Granny," utterly unreliable and 6. Bowline. 

worthless; to be avoided. 7. Slip-noose. 

3. Surgeon's. 8. Swedish fisherman's. 

4. Staffordshire. 

Illustration and practical demonstration. 



52 LECTURES ON MINOR SURGERY. 

LECTURE IX. 

Drainage. 
Wound secretions. 
History of drainage : Guy de Chauliac, 1300-1370 ; Chassaignac, 1859, tubular drainage. 

I. Natural, as by position. Open treatment ; secondary suture. 
II. Artificial. 

1. Tubular. 

a. Rubber tubes : flexible, slightly irritating, easy to manipulate, capable of 

sterilization, easily applicable, cheap and accessible, 
a. How prepare. 
ft. How use. 
y. When remove. 
8. How remove. 

b. Metal tubes. 

a. Glass, most often used in abdomen. 
ft. Silver or gold for special purposes. 

c. Absorbable tubes, of decalcified bone of ox, horse, or chicken ; ivory. 

a. Method of preparation. 
ft. How sterilized. 
7. How preserved. 
S. How disappear, 
e. Duration. 
C Objections. 
Absorbable tubes are little used now. 

2. Capillary. 

a. Catgut. 

b. Silk. 

c. Silkworm gut. 

d. Horsehair. 

e. Spun glass. 

f. Gauze. 

g. Miculicz drain. 

h. Wicking, one of best methods. 
Primary drainage. 
Secondary drainage. 
Through drainage. 



5 8 LECTURES ON MINOR SURGERY. 

LECTURE X. 

Sponges. 

I. Requisites. 

i. Open texture. 

2. Fine celled. 

3. Elastic. 

4. Power of absorption. 

II. Natural, should be used only once. 

1. Method of cleansing. 

2. Method of bleaching. 

3. How made aseptic. 

4. How preserved. 

5. Objections. 

a. Difficulty of primary cleansing and sterilization. 

b. Require too much handling. 

III. Artificial : gauze pads, used only once. 

1. How made. 

2. How made aseptic. 

3. Recommendation. 

a. Easily and surely sterilized. 

b. Minimum of handling. 

Be careful in using about the natural cavities of the body, especially the abdominal. 
Count before and after using. 



Stomach Pump. 

How to use ; caution in using it. Now practically obsolete. Displaced by following : — 
Syphonage. 

1. Of stomach. 

a. For washing out. 

b. For examination of contents. 

c. For removal of poisons. 

d. For feeding. 

2. Of bladder. 



64 



LECTURES ON MINOR SURGERY. 



LECTURE XI 



Needles. 



I. 



Characteristics of a needle : temper, 
i. Shape. 

a. Curved sharply. 

b. Curved slightly. 

c. Curved in lower third, straight 


6. 

7- 

8. 

9- 


Needles with open eye. 
Hagedon needle. 
Keith. 
Packard. 




shank. 


IO. 


Martin. 




d. Straight. 


ii. 


Smith. 




e. Curved sharply with a long 
shank. 


12. 


Needles in handles. 
a. Aneurism. 


2. 

3- 

4- 


Ordinary sewing needle. 
Insect needle. 
Acupressure needle. 




b. Reverdin. 

c. Special, as for perineum 

d. Endless thread (Goz.). 


5- 


Long needles for uterine stump or 
a pedicle. 







Needle-Holders . 

i. Von Langenbeck (best for all-round work). 

2. Dieffenback or Roser. 

3. Reiner. 

4. Special holders (as for eye). 

5. Hagedon. 

6. Downs. 



There are many others, but these were selected to illustrate types. 



7° LECTURES ON MINOR SURGERY. 

LECTURE XII. 

Sutures. 
I. General classification. 

i. " Stitches of coaptation " — superficial. 

2. " Stitches of approximation " — intermediate. 

3. " Stitches of relaxation " — deep. 

II. 



Requisites of a suture. 






1. Fine. 


6. 


Readily tied in a knot. 


2. Smooth. 


7- 


Readily removed. 


3. Strong enough for required strain. 




a. Mechanically. 


4. Soft and pliable, to adapt itself. 




b. By absorption. 


5. Readily follow the needle. 


8. 


Non-irritating. 



III. Common agents. 

1. Silk speaks for itself, when the failings of others are considered. 

2. Catgut. \ 

Sheep gut. >■ Best absorbable, and now more used than any others. 
Goat gut. ) 

a. Not so manageable as silk. 

b. More troublesome to tie. 

c. More difficult to secure exact coaptation. 

d. More trouble to prepare. 

e. Dangerous if not properly prepared. 

f. May absorb too quickly. 

3. Silkworm gut. 

a. Polished and smooth. 

b. Strong and transparent. 

c. Unchangeable and non-irritating. 

d. Stiff and difficult to tie. 

e. Especially praised in ruptured perineum, vaginal fistutee and fissured palate. 
f. Not adapted to very fine work. 

4. Horsehair. 

a. Very pliant, smooth, strong, delicate and non-irritating. Highly praised 

by those who use it. 

b. Needs care in preparation and in tieing; easily removed, as are all 

foregoing. 



7& LECTURES ON MINOR SURGERY. 



LECTURE XIII. 

Sutures, — Continued. 

III. Common agents, — Continued. 

5. Metal. Wires of lead, copper covered with gutta percha, iron, gold and silver 
have been used. Silver is now most used because — 

a. Of ease of fastening. 

b. Of accuracy of adaptation. 

c. Of support and immobilization. 

d. Of ease of regulating tension. 

e. Smooth, pliable, non-irritating. 
/ It may be left indefinitely. 

g. Deep suture to relax borders. 

h. For suturing bone. 

i. Objections : not adapted to fine work ; not so readily removed. 

IV. Application of the suture. 

Order of application usually — 

a. Deep. 

b. Intermediate. 

c. Superficial. 
Tie in reverse order. 

Removed in from three to five, 
eight to twelve days. 

How to remove the various kinds. 

Support parts after removal by 
adhesive plaster, truss, band- 
age, etc. 

Pilot thread for metal ; describe 
and illustrate. 



I. 


Line of passage of the suture. 


7- 


2. 


Distance from edge of wound. 




3- 


Edges must not incurve. 




4. 


May be tied at once, or all inserted 
and then tied. 




5- 


Knot. 

a. Do not tie in wound line. 


8. 




b. Do not strangulate, else ex- 


9- 




cite inflammation, suppura- 


10. 




tion and cutting of tissues. 




6. 


Various sutures may be used 






together. 


11. 



82 LECTURES ON MINOR SURGERY. 

LECTURE XIV. 

Sutures, — Continued. 
V, Classification. 



i. Interrupted, typical suture. Deep and intermediate sutures always of this 
variety. 

2. Continuous suture, "glover's stitch," " over-and-over " stitch. 

a. Superficial, usually of this variety. 

b. Describe application ; differentiate right and wrong way. 

c. Describe tieing at each end. 

3. Buried suture, continuous or interrupted. 

4. Buried skin suture, continuous. 

a. Requisites. 1 

b. How apply. 

c. How fasten at beginning and at end. 

5 . Button suture : a suture of relaxation. 

a. How used. 

b. Advantages. 

6. Quilt suture. 

7. Coil suture. 

8. Pin suture or hare-lip suture ; practically obsolete. 

9. Quill suture; practically obsolete. 

10. Bead suture ; practically obsolete. 

11. Elastic suture; practically obsolete. 

12. Herring-bone suture, useful in post-mortem work. 

r Wire. 

13. Bone sutures-^ Catgut. 

( Silkworm gut. 

14. Special sutures. 

a. McBurney suture. 

b. Halstead suture. 

Practical demonstration of ligatures, knots, sutures, etc. 



88 LECTURES ON MINOR SURGERY. 

LECTURE XV. 

Sutures, — Continued. 

V. Classification, — Continued. 
15. Visceral sutures. 

a. General considerations. Recognition of three coats to the intestine 

necessary. 

b. Requisites of a visceral suture. 

a. Firm grasp of intestinal walls. 

(3. Non-puncture of whole thickness of wall. 

y. Firm apposition of peritoneal surfaces. 

8. Applied close enough to prevent leakage. 

e. As fine a suture material as possible. 

£. Apply always with a round needle as small as possible. 

rj. Make principal sutures of silk to hold intestinal walls in close 

coaptation. 
0. Make reinforcing peritoneal sutures of fine catgut. 

c. Varieties of visceral sutures. 

a. Lembert : interrupted or continuous. Passed through the serous 
and muscular coats of the intestine down to, but not through, the 
mucous coat. Sometimes called Dupuytrens suture. 

/?. Jobert : passed through all the coats of the intestine ; drawn tightly, 
it cuts through into intestine and is so gotten rid of. Objection : 
every stitch punctures the intestine and, during extreme gas 
distention, may leak. 

y. Emmert : interrupted. In results no better than others. Objec- 
tion : too much time to apply. 

8. Gely : continuous ; two needles and one long thread. Results 
excellent, but too tedious in application. 

e. Czerny : combination. Edges of peritoneum and muscular coat are 
sutured together by fine interrupted suture ; then Lembert suture 
is applied. 

£. Gussenbauer : interrupted. Combination of Lembert and Czerny 
in one thread. 

Remarks. — As good results as any are obtained by a double continuous suture (Lembert) 
the second one applied over the first. 



94 LECTURES ON MINOR SURGERY. 

LECTURE XVI. 

Bandaging. 

I. General Consideration of bandages. 

II. The Roller bandage. 
i. Uses of. 

2. How to make it by hand ; by machine. 

3. How to apply it. 

a. Circular turns. 

b. Spiral reversed turns. 

c. Figure of eight turns. 

d. Recurrent turns, for ends of fingers, etc., or for stump. 

The whole art of bandaging with a roller is only a combination of these turns. 

Practical demonstration of how to make a roller from a piece of cloth seven yards 
long, which is torn into strips of variable width ; each student has a strip given him, which 
he rolls and re-rolls under inspection until he has accomplished an understanding of how 
to do it. 



LECTURES ON MINOR SURGERY. 



LECTURE XVII. 

Bandaging, — Continued. 



III. Special bandages. 
i. Of the foot. 

2. Figure eight of the ankle. 

3. Spiral reversed of the leg. 

4. Figure eight of the knee. 



5. Figure eight of the knee at differ- 

ent angles of flexure. 

6. Spiral reversed of the thigh. 

7. Complete bandage of the entire 

lower extremity. 



Practical demonstration and illustration on a living model. 



io6 



LECTURES ON MINOR SURGERY. 



LECTURE XVIII. 



Bandaging, — Continued. 



III. Special bandages, — Continued. 

8. To cover in the end of a finger. 

9. Of a finger. 

10. Of all the fingers. 

11. Of the thumb. 

12. Of the whole hand and wrist 

the gauntlet. 

13. Of the forearm. 



14. 
J 5- 

16. 

17. 
18. 



Figure eight of the elbow. 

Figure eight of the elbow at dif- 
ferent angles of flexure. 

Of the arm. 

Spica bandage of the thumb. 

Complete bandage of the entire 
upper extremity. 



Practical demonstration and illustration on a living model. 



H2 LECTURES ON MINOR SURGERY. 



LECTURE XIX. 



Bandaging, — Continued. 

III. Special bandages, — Continued. 

19. Spica bandages of the shoulder. 

20. Spica bandages of the hip and groin. 

21. Double spica of the hip and groin. 

22. Bandages of the head. 

a. Occipito-facial ; valuable for the retention of dressings. 

b. Figure of eight for one or both eyes. 

c. Fronto-occipito-cervical figure of eight. 

d. Fronto-occipito-mental figure of eight. 

Practical demonstration and illustration on a living model. 



n8 



LECTURES ON MINOR SURGERY. 



LECTURE XX. 



Bandaging, — Continued. 



III. Special bandages, — Continued. 

22. Bandages of the head. — Continued, 
e. Barton's bandage. 

f. Gibson's bandage. 

g. Recurrent bandage of the 

scalp ; the capeline. 



23- 



24. 



Bandages of the chest. 

a. For retaining dressings. 

b. For fractured rib. 

c. Of one breast. 

d. Of both breasts. 
Bandage of fractured lower jaw. 



Practical demonstration and illustration on a living model. 



124 LECTURES ON MINOR SURGERY. 



LECTURE XXI. 

Bandaging", — Continued 

III. Special bandages, — Continued. 

25. Bandages for fractured clavicle. 

a. Sayre's bandage. 

b. Velpeau bandage. 

c. Desault bandage ; useful for fractured clavicle, fractures of the acromion 

or coracoid process, and of the anatomical neck of the humerus. 

26. T bandage; single and double-tailed. 

27. Four-tailed bandage. 

28. Six-tailed bandage. 

29. Many-tailed bandage. 

30. Handkerchief bandages. 

a. Four-tailed for vertex and occiput. 

b. Square cap for the head. 

c. For the shoulder. 

d. For the hand. 

e. For the thigh. 
/. For the hip. 
g. For the foot. 

31. Cravat bandages. 

32. Slings. 

a. Encircling the neck. 

b. Leaving shoulder of the injured side free. 

c. Leaving shoulder of the opposite side free. 



Practical demonstrations and illustration on a living model. 



130 LECTURES ON MINOR SURGERY. 

LECTURE XXII. 

Bandaging, — Continued. 

III. Special bandages, — Continued. 
33. Immovable bandages. 

a. Materials. 

a. Starch. 

fi. Plaster of Paris. 

y. Silicate of potash or soda. 

8. Glucose. 

b. Uses of. 

c. Precautions in application. 

a. Do not apply next to the skin. 

/J. Do not apply over an open wound, unless surely aseptic. 

y. Maintain desired position of parts until sufficiently set or dried. 

8. If painful after application, remove and re-apply. 

€. Do not apply too soon after an injury. 

d. Plaster of Paris jacket. 



Practical demonstration of application of plaster of Paris jacket on a living model. 



i3 6 LECTURES ON MINOR SURGERY. 

LECTURE XXIII. 

Bandaging, — Continued. 

III. Special bandages, — Continued. 

32>- Immovable bandages, — Continued, 
e. Silicate of potash bandage. 
/. Bavarian splint. 

Practical demonstration of both on a living model. 



142 LECTURES ON MINOR SURGERY. 

LECTURE XXIV. 
Splints and Fracture Dressings. 

i. General principles of splints. 

2. Materials. 

a. Metal : shaped, in sets, and excellent. 

b. Wood : also shaped, and in sets ; excellent. 

c. Pasteboard. 

d. Gutta-percha. 

e. Leather. 

f. Plaster of Paris and many other substances. 

3. Kinds. 

a. Straight : anterior and posterior, internal and external. 

b. Angular : anterior, movable angle, posterior, internal and external. 

c. Special splints innumerable. 

d. Extension splints. 

e. Fracture box. 
f. Extension and counter-extension by means of splints, weights and pulleys, inclined 

planes, etc. 



Practical demonstration on a living model. 



148 LECTURES ON MINOR SURGERY. 

LECTURE XXV. 

Instruments. 

1. Pocket cases. 

2. Aspirator and aspiration. 

3. Tracheotomy case, exhibited and explained. 

4. Post-mortem case. 

5. Amputation or general operating case. 

Various instruments exhibited and explained, with general instructions for their care. 



154 LECTURES ON MINOR SURGERY. 

LECTURE XXVI. 

Sepsis. 

This term includes all surgical conditions due to bacterial infection. 
History of inception of present day understanding, which began with Lister in 1867-69. 
History of Listerism — 
Carbolic acid. 
Spray. 

Absorptive dressings. 
Protection from air. 

Wonderful results which revolutionized previous methods. 
Almost universal adoption of Listerism. 
Divided into — 

I. General infection. 

1. Acute septicaemia. 

2 . Pyaemia. 

3. Sapraemia. 

4. Toxaemia. 
II. Local infection. 

1. Suppuration. 

a. Stitch abscesses. 

b. Wound abscesses. 

c. Metastatic abscesses — usually due to infectious emboli or transporta- 

tion of infection to a new focus. 

2. Gangrene. 

3. Diphtheria. 
• 4. Erysipelas. 
Pyogenic micro-organisms. 

/■ Staphylococcus pyogenes aureus. 

Most common, < Streptococcus pyogenes. 

( Bacterium coli commune. 

r Staphylococcus epidermidis albus. 

" pyogenes albus. 

Less common, -l tl « • 

" " citreus. 

L Gonococcus of Neisser. 

Bacillus pyocyaneus ; bacillus of green pus. 

Least common, \ " aerogenes capsulatus ; gas producer; not a pus producer. 

Micrococcus lanceolatus ; diplococcus pneumoniae. 



160 LECTURES ON MINOR SURGERY. 

LECTURE XXVII. 

Antisepsis. 

Opposed to sepsis. Includes all means which are used to limit or destroy the agents 
of sepsis. 

I. Antiseptics. 

Arrest fomentation and putrefaction, but do not necessarily destroy micro-organisms. 

II. Disinfectants. 

Kill pathogenic or putrefactive organisms. 

III. Deodorants. 

May be neither disinfectant nor antiseptic and are valueless for surgical purposes. 



166 LECTURES ON MINOR SURGERY. 

LECTURE XXVIII. 

Antisepsis, — Contimted. 

IV. Agents. 

i. Carbolic acid. 

Used in solutions of i to 20 to i to 40. 
Carbolic spray, theory of its effects. 

2. Corrosive sublimate. 

Used in solutions of 1 to 500 to 1 to 5,000. 
Care in use ; not safe in abdominal cavity. 
1 to 2,000 to 1 to 2,500 most common. 

1 to 5,000 useless unless enormous amount is used, continued for a long 
time and hot. 
No solution sufficiently strong to be effective is safe about the mucous or 
serous surfaces and membranes. 

3. Permanganate of potash and oxalic acid 

4. Creolin 



. Types of coal tar derivatives. 

5. Lysol \ 

6. Formaldehide. 

Formalin, one-half of one per cent, to two per cent, solution. 

7. Per-oxide of hydrogen. 

8. Heat : the ideal disinfectant. 

a. Moist. 

a. Boiling water. 

(3. Soda solution. 

y. Steam. 

8. Steam under pressure. 

b. Dry heat : actual flame. 

9. Soda and chloride of lime. 

Theory of action. 



i7 2 LECTURES ON MINOR SURGERY. 

LECTURE XXIX. 

Asepsis. 

Complete absence of sepsis, an ideal condition difficult to obtain. Obtained in surgery 
by excluding all pathogenic organisms from operative field. Such a field is said to be sterile. 

Surgical sterilization means employment of a method which includes absolute and 
complete freedom from bacteria. 

Methods : — 
i. Heat. 

a. Dry. 

b. Moist. 

2. Chemical disinfectants. 

3. Mechanical cleansing; removes all extraneous matter ; disinfection by removal. 

4. Fractional sterilization. 



i 7 8 



LECTURES ON MINOR SURGERY. 



LECTURE XXX. 



I. 



II. 



III. 



IV. 



Anaesthesia. 



Exaltation. 



Primary effects : disturbance of function. 
Stage of excitement. 

i. Excitation (local) of nerves of respiratory passages. Taste and smell and 
naso-pharyngeal branches of fifth pair of nerves powerfully excited. 
Excessive salivary secretion with frequent deglutition. 
Tickling in larynx and cough. 
Sense of suffocation ; resistance. 
Humming in ears. 
Flashes of light -before the eyes. 
Heart pulsations quickened and can be felt. 
8. Vessels throb; perspiration; heat flashes; quickened respiration ; pupils 
contract, eyes close ; all reflexes disturbed, involuntary urination or even 
defecation, and general appearance of intoxication. 
Secondary effects : paralysis of function. 

Stage of anaesthesia. " Surgical anaesthesia." 
Skin loses sensibility. 



6. 



2. Pupils contracted. 

3. Temperature falls. 

4. Pulse goes to normal or below. 

5. Blood pressure less. 
Tertiary effects : dangerous. 

Stage of profound anaesthesia. 

1. Syncope. 

2. Embarrassed respiration. 

3. " heart's action. 

4. Pupils widely dilated, remain- 

ing so until death. 
Consideration of details. 
Eyes. 

General sensibility. 
Brain. 
Volition. 

Muscular movements. 
Respiratory movements. 



Respiration deep, full, and 

involuntary. 
Voluntary motion lost. 
Reflexes abolished. 
Complete insensibility. 



Asphyxia. 

Snoring respiration. 

Death. 



9- 
10. 



Heart. 

Temperature. 
Secretion. 

Recovery, inversion of 
nomena. 



phe- 



184 LECTURES ON MINOR SURGERY. 

• 
LECTURE XXXI. 

Anaesthesia, — Continued. 

V. Administration of anaesthesia. 
i. Preparation of patient. 

a. Abstinence from food for four to six hours. 

b. Last food taken light and digestible, as beef tea or mutton broth. Milk 

improper. 

c. Prevent stomach contents from entering trachea, in case of vomiting. 

Best to have stomach empty. 

d. Recumbent position. 

<?. Remove false teeth and foreign substances from mouth. 

f. No constricting bands about neck or body. 

g. Mind quiet. 

h. One ounce whiskey as stimulant before anaesthetic in selected cases. 
i. Be careful in presence of artificial light. 

j. Watch pulse and respiration. 
k. Tongue forceps and mouth gag. 

2. Ether, a stimulant. Ethylic oxide; ethylic ether; sulphuric ether. Boiling 

point ninety-six degrees. 

a. Open administration. 

b. Closed administration. 

3. Chloroform, a depressant. It paralyzes heart muscles or contained ganglia. 

Full blood pressure, due to direct action on heart. 

VI. Choice of anaesthetic. 
1. Ether preferred. 

a. Organic brain diseases. 

b. Brain tumors. 

c. Atheromatous vessels. 

d. Organic diseases of heart. 

e. In cases requiring long-continued narcosis. 






190 LECTURES ON MINOR SURGERY. 

LECTURE XXXII. 

Anaesthesia, — Continued. 

VI. Choice of anaesthetic, — Continued. 
2. Chloroform. 

a. Puerperal conditions. 

b. In very young. 

c. In very old, or where senile changes are marked. 

d. In organic diseases of lungs. 

e. In organic diseases of kidneys. 

f. In cases requiring brief narcosis. 
VII. If danger threatens. 

1. Remove all obstruction to respiration. 

2. Draw tongue forward. 

a. By direct traction on tongue. 

b. Forcibly carrying lower jaw forward. 

3. Extension of head and neck. 

4. Slight shock by 

a. Slapping with cold wet towel. 

b. By pouring ether on to chest or spine. 

5. Inversion of body. 

6. Drugs, — alcohol, ammonia, amyl-nitrite, digitalis, atropine, caffeine, 

strychnia, 1/50 gr., hypodermatically. 

7. Artificial respiration. 
Nitrous oxide. 

" " and ether. 

" " " chloroform. 

Chloroform " ether. 

" " oxygen. 

The ACE mixture. 
Local anaesthesia. 
Salt and ice. 
Ethyl chloride. 
Cocaine. 
Eucaine. 
Schleisch's method. 






196 LECTURES ON MINOR SURGERY. 



LECTURE XXXIII. 

Vaccination. 

Introduced to notice in 1798. 
History of smallpox. 

Illustrations of former ravages of smallpox. 

Most deaths in children under ten years. 

Immunity was general. Deaths among a small proportion of population. Where 

no protection from previous epidemics, death rate frightful. 
Originated probably in China or India. 
Unknown in Europe until end of sixth century. Variola — from varus, a pimple; 

or varius, spotted. 
Inoculation known in China ages before disease known in England, by inserting 

crusts in nose. 
In Turkey, inoculation early in eighteenth century. 
In England, introduced from Turkey, in 1721. 
First done May 14, 1796, by taking matter from vesicle of cowpox. Human to 

human, arm to arm vaccination. 
Early in present century, Jenner published his " Inquiry." 
Then followed many experiments. 
Vaccine vesicle — a multilocular structure. 

1. Papular stage — stage of inflammation. 

2. Stage of umbilication. 

3. A true vesicle — converted into 

4. A pustule. 

5. A crust. 

6. Desquamation. 
Animal vaccination. 
How to vaccinate. 
Time of immunity. 

Complications and sequelae of vaccination. 



AUG 26 »«* 



